2012, English, Thesis
The impact of food subsidy programs on the health of disadvantaged populations : an evaluation of subsidised fruit and vegetables in a rural Aboriginal medical service / Andrew Black.
Thesis (PhD)--University of South Australia, 2012.
Includes bibliographical references (p. 179-216)
Nutrition is a significant factor underpinning people’s health. Australian surveys have shown that social disadvantage correlates with poorer health outcomes, higher rates of chronic disease and lower adherence to nutrition guidelines. This is reflected in the life expectancy gap between Aboriginal and Torres Strait Islander people and non-Indigenous Australians. In this context effective interventions to improve nutrition are important to inform nutrition policy development. Subsidising healthy foods for those on low incomes is one strategy that has not been widely trialled in Australia. To contribute to the evidence base for healthy food subsidies, this thesis reports on (i) the evaluation of a program of subsidised fruit and vegetables for disadvantaged Aboriginal families at three rural Aboriginal Health Services, and (ii) a systematic review of food subsidy programs in high income countries. To contribute to the evidence base for healthy food subsidies, this thesis reports on (i) the evaluation of a program of subsidised fruit and vegetables for disadvantaged Aboriginal families at three rural Aboriginal Health Services, and (ii) a systematic review of food subsidy programs in high income countries.
The evaluation was conducted on the Bulgarr Ngaru Medical Aboriginal Corporation fruit and vegetable program that incorporates subsidised fruit and vegetables with preventive health screening and nutrition promotion. A before and after study design was used to assess the impact on the nutritional and health status of participating children. The nutritional assessments included 24-hour dietary recalls and measurement of biomarkers of fruit and vegetable intake in bloods. Health outcomes were assessed with retrospective clinical record audits and anthropometric data. Focus groups and key informant interviews were used to document the implementation and sustainability of the program.
A cohort of 57 new families was recruited for this evaluation. Baseline assessment in 149 children showed low fruit and vegetable consumption. Twelve month follow-up of 129 children showed significant increases in β-cryptoxanthin (p=0.027), vitamin C (p=0.013), lutein-zeaxanthin (p=0.026) and red cell folate, although self-reported fruit and vegetable intake was unchanged. There were also significant decreases in episodes of illness (14%, p=0.037), hospital attendances (25%, p=0.017) and oral antibiotics (34%, p=0.001) during participation in the program. The success of the evaluation depended on the ongoing relationships between the health services and the Aboriginal communities and the practical nature of the intervention.
The improvements in biomarkers of fruit and vegetable intake and short-term health outcomes demonstrated in this study, though not conclusive, indicate the need for a more controlled study of healthy food subsidies in Australia. This, together with an economic analysis, would facilitate a thorough assessment of the costs and benefits of subsidising healthy foods. The most important implication of this thesis is the potential reduction in chronic disease rates, if food subsidy programs lead to sustainable increases in fruit and vegetable intake. Thus, food subsidies could, if effective, reduce the social inequalities in health by improving the nutrition of disadvantaged Australians, particularly Aboriginal and Torres Strait Islander people.
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